Craig Miller: 4 Strategies to Combat Healthcare Fraud

1. Recognize the three most frequent kinds of fraud and develop separate approaches to combat them: Identity fraud, Transactional fraud, Collusive fraud
2. Implement data fusion. One reason that fraud detection is so hit-or-miss is that payment decisions are usually based solely on the information within claims.
3. Understand that fraud is evolving. As we gradually move from a pure fee-for-service healthcare model to global payment approaches fraud will change rather than disappear.
4. Recognize “pay & chase” is only part of solution. Deny payment for suspicious transactions using predictive modeling, now widely deployed in the financial services industry.

Source: Government Health IT
Source URL: http://www.govhealthit.com/news/4-strategies-combat-healthca...

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